3 Common Reasons For Disability Denials
We're Here to Prevent Denials
1) You Have Not Been Disabled 12 Months or More.
By definition, Social Security considers you disabled when the medical condition which prevents you from working has lasted 12 months, is expected to last 12 months or is expected to result in death. This does not mean you have to wait 12 months to file your claim. In fact, we encourage all our clients to apply right away, as some benefits are only calculated from the date you first apply. But it does mean, that with certain types of claims you will be declined because you haven't been out of work 12 months and your condition may be expected to improve. For instance, if you were injured in a car wreck and have been on a no work status for 6 months when you apply for disability, you might be declined because your doctor expects your condition will improve to the point where you can return to work.
Each case is unique. Social Security decides your case in part, on whether your medical records indicate you have already been out of work 12 months or are expected to be out of work 12 months. As attorneys, we see a lot of denials because clients have not met this 12 month disability period. We can often correct the problem by obtaining information from your doctor about how long your condition will last.
2) Your Condition Was Not Disabling Before Your Date Last Insured.
Believe it or not, you can actually wait too long to file a claim for disability. When you work and earn money, the FICA taxes taken out of your paycheck are used to pay your Social Security insurance premium for disability benefits. When you stop working, you stop paying your taxes and insurance premiums. When this happens, you can lose your insured status. Your insurance typically runs out 5 years after you stop working. For example, if you stopped working in calendar year 2006 because of a disability, you might only be insured through the year 2011, 5 years after you stopped working. This is known as your date last insured, or DLI, and it is critical to your case. Social Security must determine that your disability began before your date last insured. If Social Security determines that your disability began after your date last insured, you would not be eligible for disability benefits.
Be advised this rule only applies to Title II disability claims, not claims for Supplemental Security Income, SSI, claims.
If you received a denial based on your date last insured there are a few steps you can take to fix the problem. First, look at the denial letter for Retirement, Survivors and Disability Benefits. The last page will always reference your date last insured. The denial will state " we did not find your condition disabling on or before xx/xx/xx, and a date will be inserted. Think about your medical condition. If you have any medical proof you were disabled before that date, consider amending your claim to allege an earlier onset date.
3) You Are Not Capable of Performing Work You Have Done in the Past.
In order to be found disabled, Social Security must first determine that you are not working and earning over a certain income level; that you have a serious medical impairment and that you are not capable of performing your prior work. SSA uses the work history you provide in your application to come up with general parameters for the physical and mental demands of your past work. They then look at your medical records to try and determine whether you can still meet the demands of your prior work. If your medical records do not specifically address your work restrictions you may have difficulty getting approved. Social Security will simply select the lightest job you described and conclude you can still perform that work.
The main problem in this situation is usually an absence of medical records which define your restrictions. Most medical records contain information about your complaints, diagnosis, symptoms, treatment and medications. The medical records may not say anything about how much you can lift, bend, push, pull, etc. Social Security may write your physician for input on your restrictions, but if your doctors fail to respond, SSA will use its own, often non-medically trained, personnel to decide your case.
As attorneys, we prefer not to leave your case to chance. We want to get your doctors to actually outline your restrictions. If your doctors spell out your restrictions and those restrictions support your inability to return to your prior work, then your odds of winning in most circumstances are much improved.
Contact Us For Help
If you have received a denial, you have 60 days to appeal.
If you need help appealing or would like to speak with one of our attorneys about your case, call Harris & Riviere at our Tampa office, (813) 669-2080 or contact us online.
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